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NPI Code Detail

MEDICARE: ELLYSON JAMEL HUBBARD APRN

MEDICARE: ELLYSON JAMEL HUBBARD APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN11042888FL

General Provider Information

NPI Number : 1285188946
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLYSON JAMEL HUBBARD APRN
Provider Business Mailing Address
First Line : 1801 LEE RD STE 165
Second Line :
City : WINTER PARK
State : FL
Zip : 32789-2127
Country : US
Telephone Number : 407-821-3547
Fax Number : 407-821-3548
Provider Business Practice Location Address
First Line : 1801 LEE RD STE 165
Second Line :
City : WINTER PARK
State : FL
Zip : 32789-2127
Country : US
Telephone Number : 407-821-3547
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2016
Last Update Date : 11/21/2025

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